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Connecticut rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $17.38 / $134.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.19 / $0.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.13